Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRIDENT II TRITAN SOLIDBK 56F

Facility

$5,888.55

Service Code	HCPCS C1776
Hospital Charge Code	270699331
Hospital Revenue Code	278
Min. Negotiated Rate	$141.91
Max. Negotiated Rate	$2,944.28
Rate for Payer: Aetna Commercial	$2,237.65
Rate for Payer: Aetna Medicare Advantage	$1,766.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,501.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,501.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,501.58
Rate for Payer: Cigna Commercial	$2,944.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,295.48
Rate for Payer: Qualcare PPO/HMO/WC	$883.28
Rate for Payer: UnitedHealthcare Community & State	$141.91
Rate for Payer: Wellpoint Medicaid Managed Care	$156.05

TRIDENT II TRITAN SOLIDBK 60G

Facility

$12,287.50

Service Code	HCPCS C1776
Hospital Charge Code	270699343
Hospital Revenue Code	278
Min. Negotiated Rate	$1,843.12
Max. Negotiated Rate	$2,973.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,457.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,973.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,703.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.12

TRIDENT II TRITAN SOLIDBK 60G

Facility

$12,287.50

Service Code	HCPCS C1776
Hospital Charge Code	270699343
Hospital Revenue Code	278
Min. Negotiated Rate	$296.13
Max. Negotiated Rate	$6,143.75
Rate for Payer: Aetna Commercial	$4,669.25
Rate for Payer: Aetna Medicare Advantage	$3,686.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,133.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,133.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,133.31
Rate for Payer: Cigna Commercial	$6,143.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,973.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,703.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.12
Rate for Payer: UnitedHealthcare Community & State	$296.13
Rate for Payer: Wellpoint Medicaid Managed Care	$325.62

TRIDENT LINER X3 10D INST 36MM

Facility

$4,275.85

Service Code	HCPCS C1776
Hospital Charge Code	270692859
Hospital Revenue Code	278
Min. Negotiated Rate	$641.38
Max. Negotiated Rate	$1,034.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$940.69
Rate for Payer: Qualcare PPO/HMO/WC	$641.38

TRIDENT LINER X3 10D INST 36MM

Facility

$4,275.85

Service Code	HCPCS C1776
Hospital Charge Code	270692859
Hospital Revenue Code	278
Min. Negotiated Rate	$103.05
Max. Negotiated Rate	$2,137.93
Rate for Payer: Aetna Commercial	$1,624.82
Rate for Payer: Aetna Medicare Advantage	$1,282.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,090.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,090.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,090.34
Rate for Payer: Cigna Commercial	$2,137.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$940.69
Rate for Payer: Qualcare PPO/HMO/WC	$641.38
Rate for Payer: UnitedHealthcare Community & State	$103.05
Rate for Payer: Wellpoint Medicaid Managed Care	$113.31

TRIDENTX3 10DPOLY INSERT 36MMG

Facility

$4,458.50

Service Code	HCPCS C1776
Hospital Charge Code	270695399
Hospital Revenue Code	278
Min. Negotiated Rate	$107.45
Max. Negotiated Rate	$2,229.25
Rate for Payer: Aetna Commercial	$1,694.23
Rate for Payer: Aetna Medicare Advantage	$1,337.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,136.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,136.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,136.92
Rate for Payer: Cigna Commercial	$2,229.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$980.87
Rate for Payer: Qualcare PPO/HMO/WC	$668.77
Rate for Payer: UnitedHealthcare Community & State	$107.45
Rate for Payer: Wellpoint Medicaid Managed Care	$118.15

TRIDENTX3 10DPOLY INSERT 36MMG

Facility

$4,458.50

Service Code	HCPCS C1776
Hospital Charge Code	270695399
Hospital Revenue Code	278
Min. Negotiated Rate	$668.77
Max. Negotiated Rate	$1,078.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$980.87
Rate for Payer: Qualcare PPO/HMO/WC	$668.77

TRIDESILON .05% OINT/15GM

Facility

$61.00

Hospital Charge Code	60634301
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

TRIDESILON .05% OINT/15GM

Facility

$61.00

Hospital Charge Code	60634301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$12.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$12.20
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

TRIDIL/5MG/1ML

Facility

$48.00

Hospital Charge Code	60634065
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

TRIDIL/5MG/1ML

Facility

$48.00

Hospital Charge Code	60634065
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

TRIDIL STARTER KIT/50MG/1

Facility

$95.00

Hospital Charge Code	60634067
Hospital Revenue Code	250
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.50
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

TRIDIL STARTER KIT/50MG/1

Facility

$104.00

Hospital Charge Code	60634066
Hospital Revenue Code	250
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

TRIDIL STARTER KIT/50MG/1

Facility

$104.00

Hospital Charge Code	60634066
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$39.52
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$20.80
Rate for Payer: UnitedHealthcare Community & State	$2.51
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

TRIDIL STARTER KIT/50MG/1

Facility

$95.00

Hospital Charge Code	60634067
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

TRIDILVIP/50MG/VIAL

Facility

$101.00

Hospital Charge Code	60634268
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

TRIDILVIP/50MG/VIAL

Facility

$101.00

Hospital Charge Code	60634268
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$20.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$20.20
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

TRIDTIIPSLCLUSTHOLEHAACESH52MM

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270691240
Hospital Revenue Code	278
Min. Negotiated Rate	$714.75
Max. Negotiated Rate	$1,153.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$953.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,048.30
Rate for Payer: Qualcare PPO/HMO/WC	$714.75

TRIDTIIPSLCLUSTHOLEHAACESH52MM

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270691240
Hospital Revenue Code	278
Min. Negotiated Rate	$114.84
Max. Negotiated Rate	$2,382.50
Rate for Payer: Aetna Commercial	$1,810.70
Rate for Payer: Aetna Medicare Advantage	$1,429.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$953.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,215.08
Rate for Payer: Cigna Commercial	$2,382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,048.30
Rate for Payer: Qualcare PPO/HMO/WC	$714.75
Rate for Payer: UnitedHealthcare Community & State	$114.84
Rate for Payer: Wellpoint Medicaid Managed Care	$126.27

TRIDTIIPSLCLUSTHOLEHAACESH54MM

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270691241
Hospital Revenue Code	278
Min. Negotiated Rate	$114.84
Max. Negotiated Rate	$2,382.50
Rate for Payer: Aetna Commercial	$1,810.70
Rate for Payer: Aetna Medicare Advantage	$1,429.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$953.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,215.08
Rate for Payer: Cigna Commercial	$2,382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,048.30
Rate for Payer: Qualcare PPO/HMO/WC	$714.75
Rate for Payer: UnitedHealthcare Community & State	$114.84
Rate for Payer: Wellpoint Medicaid Managed Care	$126.27

TRIDTIIPSLCLUSTHOLEHAACESH54MM

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270691241
Hospital Revenue Code	278
Min. Negotiated Rate	$714.75
Max. Negotiated Rate	$1,153.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$953.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,048.30
Rate for Payer: Qualcare PPO/HMO/WC	$714.75

TRIETHANOLAMINE OTIC 15ML

Facility

$19.20

Hospital Charge Code	6005482
Hospital Revenue Code	252
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.60
Rate for Payer: Aetna Commercial	$7.30
Rate for Payer: Aetna Medicare Advantage	$5.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.90
Rate for Payer: Cigna Commercial	$9.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.76
Rate for Payer: Oxford Commercial	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$2.88
Rate for Payer: UnitedHealthcare Commercial	$3.84
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

TRIETHANOLAMINE OTIC 15ML

Facility

$19.20

Hospital Charge Code	6005482
Hospital Revenue Code	252
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$2.88
Rate for Payer: Qualcare PPO/HMO/WC	$2.88

TRIETHYLENE THIOPHOSPHORA 15MG

Facility

$803.25

Hospital Charge Code	60627408
Hospital Revenue Code	636
Min. Negotiated Rate	$19.36
Max. Negotiated Rate	$401.62
Rate for Payer: Aetna Commercial	$305.24
Rate for Payer: Aetna Medicare Advantage	$240.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.83
Rate for Payer: Cigna Commercial	$401.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.39
Rate for Payer: Qualcare PPO/HMO/WC	$120.49
Rate for Payer: UnitedHealthcare Community & State	$19.36
Rate for Payer: Wellpoint Medicaid Managed Care	$21.29

TRIETHYLENE THIOPHOSPHORA 15MG

Facility

$803.25

Hospital Charge Code	60627408
Hospital Revenue Code	636
Min. Negotiated Rate	$120.49
Max. Negotiated Rate	$194.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.39
Rate for Payer: Qualcare PPO/HMO/WC	$120.49

Know your out-of-pocket cost for care.

All Charges